Wastewater-based epidemiology in China: A decade of advancements and challenges

Wastewater-based epidemiology (WBE) has been widely used as a public health surveillance tool worldwide, especially since the COVID-19 pandemic. In China, the WBE approach has been adopted for monitoring illicit drug use since the early 2010s and further extended to monitoring consumption or exposure to other chemicals. Establishing a nationwide monitoring program for substance consumption has increased the population coverage from 3.5 to 382 million. However, previous ∼ 200 WBE studies in China are mostly chemical-focused, with limited focus on pathogenic bacteria or viruses. Moreover, there are still challenges for the methodology as multiple factors affect the accuracy and reliability of the final back estimations. With emerging public health challenges, especially after the COVID-19 epidemic, WBE can play a more important role in China. This study summarizes achievements made in various WBE applications in China and research efforts in enhancing the accuracy and reliability of WBE results over the past decade. Future perspectives were also discussed, considering the achievements in other countries and the unique features of China. Integrating WBE estimation, both chemical and biological data, with other data would promote the development of more evidence-based strategies for public health.